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Software development for dosimetric follow up of patient undergoing CT scanners
SFPM Annual Meeting 2011
S17
TOPIC: IMAGING 26 Dosimetric warning levels in interventional radiology C. SALVAT, J. RAGOT and A. JEAN-PIERRE Hoˆpital Lariboisie`re, AP-HP, 2 rue A Pare´ 75010 Paris
Introduction: Following the incidents in Strasbourg in March 2009 that generated deterministic effects of X-rays in patients treated for interventional Neuroradiology, the French Radiation Safety Officer has published recommendations for dose optimization in neuroradiological procedures. Materials and methods: The medical staff, at Lariboisie `re Hospital, Paris, have been specially trained in theirs owns uses of radiological interventional equipment to understand deterministic effects related to the level of radiation dose. Individual patient doses have been monitored over a year to get statistical data by type of procedure (mean and standard deviation of DAP and skin exposure). We have set warning level and actions for the staff to adapt if necessary the proceedings and set the terms of the patient long term follow-up. In addition, a clinical protocol, mobilizing the room only for 20 minutes, was implemented to monitor the
performance stability of the equipment after preventive or corrective manufacturer interventions and software updates. Results: For all types of procedures, dose monitoring analysis allows a better definition of the critical stages of the X-rays interventions. It helps managing the use of radiation. In agreement with the medical supervisor, warning level and actions were defined as soon as the DAP or the skin dose has reached the average +1.5 standard deviation. The warning level established by type of procedure will be presented for interventional neuroradiology and cardiology. Conclusion: The medical physicist has a key role in interventional radiology. At our hospital, the medical staff received training in the optimization of radiological procedures. Warning levels and actions have been defined for interventional procedures requiring medical care and patient follow up for deterministic effects. Keywords: optimization, Interventional Radiology, warning levels
27 Software development for dosimetric follow up of patient undergoing CT scanners C. SALVAT, A. JEAN-PIERRE and J. RAGOT Hoˆpital Lariboisie`re, AP-HP, 2 rue A Pare´ 75010 PARIS
Introduction: Computed Tomography involves larger radiation doses than the more conventional X-rays imaging procedures. More than 27 000 patients are scanned annually on the two scanners of Lariboisie `re Hospital. Some patients, sometimes young, have a large number of CT scans for severe medical problems. The medical staff should be able to monitor dosimetric informations to identify patients with stochastic risks from X-rays exposures. Materials and methods: Radiological technologists have been trained in protocol optimization. They were used to record the Dose Length Product (DLP mGy*cm) for each helicoidal scanning and each patient in Rados software. According to the anatomical exploration location, it is possible to evaluate the effective dose multiplying the DLP by a conversion factor. A software has been recently developed based on several criteria (patient identifier, age, number of scanners, cumulative effective dose) to highlight patients consistently exposed. Results: This software will be presented in an interactive form. This tool determines the previous examinations performed in these
patients. It does monitor individual dosimetry and cumulates the effective dose. (Example: In 2010, 37 CT scans were performed in a single patient). This software allows the medical staff to identify individual patients requiring direct care due to x-rays exposure. It also raises the awareness level of radiologists to the justification of each CT explorations. Conclusion: The medical physicist plays a major role in monitoring the radiation dose in patient undergoing multiple CT scanners. The new software shows a significant potential for this. We still lack hindsight to know all the benefits. This tool does also have its limits, especially for pediatric and pregnancy explorations because only the organ dose determine the level of risk from radiation. Moreover, mistakes in manually recording the DLP can lead to false results. In the future, manufacturers should help us to record directly the dosimetric informations from their console. Keywords: CT dose, Monitoring dosimetry, Software cumulative dose
28 Optimization of paediatric scan protocols in Hospices Civils de Lyon (HCL): moving forward a best radioprotection D. DEFEZ Service de Radiophysique et radiovigilance, Bat 3B +1, 165 Chemin du grand Revoyet, 69495 Pierre Benite
Introduction: Paediatric radioprotection is a priority of the radiation physics department of HCL. The optimization of scan protocols
began on Brilliance 40 (Philips), dedicated to paediatric practice. This talk focuses on the procedure of this optimization.
S17
TOPIC: IMAGING 26 Dosimetric warning levels in interventional radiology C. SALVAT, J. RAGOT and A. JEAN-PIERRE Hoˆpital Lariboisie`re, AP-HP, 2 rue A Pare´ 75010 Paris
Introduction: Following the incidents in Strasbourg in March 2009 that generated deterministic effects of X-rays in patients treated for interventional Neuroradiology, the French Radiation Safety Officer has published recommendations for dose optimization in neuroradiological procedures. Materials and methods: The medical staff, at Lariboisie `re Hospital, Paris, have been specially trained in theirs owns uses of radiological interventional equipment to understand deterministic effects related to the level of radiation dose. Individual patient doses have been monitored over a year to get statistical data by type of procedure (mean and standard deviation of DAP and skin exposure). We have set warning level and actions for the staff to adapt if necessary the proceedings and set the terms of the patient long term follow-up. In addition, a clinical protocol, mobilizing the room only for 20 minutes, was implemented to monitor the
performance stability of the equipment after preventive or corrective manufacturer interventions and software updates. Results: For all types of procedures, dose monitoring analysis allows a better definition of the critical stages of the X-rays interventions. It helps managing the use of radiation. In agreement with the medical supervisor, warning level and actions were defined as soon as the DAP or the skin dose has reached the average +1.5 standard deviation. The warning level established by type of procedure will be presented for interventional neuroradiology and cardiology. Conclusion: The medical physicist has a key role in interventional radiology. At our hospital, the medical staff received training in the optimization of radiological procedures. Warning levels and actions have been defined for interventional procedures requiring medical care and patient follow up for deterministic effects. Keywords: optimization, Interventional Radiology, warning levels
27 Software development for dosimetric follow up of patient undergoing CT scanners C. SALVAT, A. JEAN-PIERRE and J. RAGOT Hoˆpital Lariboisie`re, AP-HP, 2 rue A Pare´ 75010 PARIS
Introduction: Computed Tomography involves larger radiation doses than the more conventional X-rays imaging procedures. More than 27 000 patients are scanned annually on the two scanners of Lariboisie `re Hospital. Some patients, sometimes young, have a large number of CT scans for severe medical problems. The medical staff should be able to monitor dosimetric informations to identify patients with stochastic risks from X-rays exposures. Materials and methods: Radiological technologists have been trained in protocol optimization. They were used to record the Dose Length Product (DLP mGy*cm) for each helicoidal scanning and each patient in Rados software. According to the anatomical exploration location, it is possible to evaluate the effective dose multiplying the DLP by a conversion factor. A software has been recently developed based on several criteria (patient identifier, age, number of scanners, cumulative effective dose) to highlight patients consistently exposed. Results: This software will be presented in an interactive form. This tool determines the previous examinations performed in these
patients. It does monitor individual dosimetry and cumulates the effective dose. (Example: In 2010, 37 CT scans were performed in a single patient). This software allows the medical staff to identify individual patients requiring direct care due to x-rays exposure. It also raises the awareness level of radiologists to the justification of each CT explorations. Conclusion: The medical physicist plays a major role in monitoring the radiation dose in patient undergoing multiple CT scanners. The new software shows a significant potential for this. We still lack hindsight to know all the benefits. This tool does also have its limits, especially for pediatric and pregnancy explorations because only the organ dose determine the level of risk from radiation. Moreover, mistakes in manually recording the DLP can lead to false results. In the future, manufacturers should help us to record directly the dosimetric informations from their console. Keywords: CT dose, Monitoring dosimetry, Software cumulative dose
28 Optimization of paediatric scan protocols in Hospices Civils de Lyon (HCL): moving forward a best radioprotection D. DEFEZ Service de Radiophysique et radiovigilance, Bat 3B +1, 165 Chemin du grand Revoyet, 69495 Pierre Benite
Introduction: Paediatric radioprotection is a priority of the radiation physics department of HCL. The optimization of scan protocols
began on Brilliance 40 (Philips), dedicated to paediatric practice. This talk focuses on the procedure of this optimization.